A new epidemiological study finds that lesbian, gay and bisexual people in Canada have higher preventable death rates than their heterosexual counterparts.
The scientific literature has repeatedly shown health gaps between lesbian, gay and bisexual (LGB) and heterosexual people.
In 2020, for instance, Statistics Canada reported that members of the LGB community were three times more likely to have experienced physical or sexual violence at some point in their lives. LGB people also reported higher rates of depression, anxiety, suicidal ideation and substance abuse than their heterosexual counterparts.
But few studies to date have examined mortality – and specifically, deaths with relatively preventable causes – in LGB populations.
Now an international research team has looked into the issue by comparing preventable mortality estimates for lesbian, gay, and bisexual adults in Canada with those for heterosexual adults.
“Respondents from LGB communities were at higher risk of all-cause mortality – specifically, the risks were higher for heart disease, accidents, HIV and suicide,” said study co-author Olivier Ferlatte, a professor in Université de Montréal’s School of Public Health and researcher with the Public Health Research Centre.
Published online in October in SMS - Population Health, the study was led by health researchers at Simon Fraser University and the University of British Columbia and also included colleagues in Vancouver, Toronto, the U.S. and Sweden.
'Minority stress' and restricted access
According to the research team, higher mortality among LGB people can be partly explained by a phenomenon called “minority stress.” This theory describes how an accumulation of real or perceived external threats to sexual minorities (such as violence, discrimination and social exclusion) combines with internalized shame and gender identity concealment to produce psychological, physiological and behavioural responses.
“This stress causes many LGB people to delay or avoid medical visits, either because they perceive or anticipate that health-care providers will stigmatize their minority sexual orientation, or because they have experienced discrimination or stigma firsthand,” Ferlatte explained.
Another possible cause of higher mortality is the fact that LGB people have less access to both social supports (they are less likely to be part of a couple, resulting in smaller family and support networks) and material resources (due to lower incomes).
Ferlatte believes the mortality gap could be closed by expanding early and general access to LGB-friendly primary and preventive health care characterized by “openness, caring and acceptance.”
An issue beyond sexual health
He sees LGB health as an overall health issue that goes well beyond sexual health. So it is critical to invest more heavily in primary care, which promotes early diagnosis of a range of conditions, including cardiovascular disease, he said.
Ferlatte also points to insufficient funding for mental health in Canada, noting that Canada is one of the few G7 countries without a national suicide prevention strategy.
“This context creates significant barriers to accessing mental health care, not to mention the fact that people are forced to wait several months and pay high fees to see a psychotherapist or a psychologist," he said.
More research with LGB communities is also needed, in Ferlatte’s view, to better understand their needs and specificities.
“We are the first research group that has described preventable mortality in the LGB population,” he noted. “We need to investigate this issue and then determine what kinds of interventions could reduce health gaps for sexual and gender minorities.”